Online Enrolment

Student Details

Enrolment Type

In Zone Out of Zone

Student's First Name

Student's Last Name

Known As

Date of Birth

Gender

Male Female Other

Current Year Level

Eldest Child at School

Current School

Name of Primary School attended

Home Address

Address Line 2

City

Suburb

Post Code

Ethnicity

Iwi/Hapu

Affiliation

Ethnic Group/s

Language Spoken at Home

Country of Birth

Nationality

Student Refugee Status/NZ Residency Status

Date of Entry into NZ

Date of Entry into NZ if attended school overseas.

Parent/Caregiver Details (1)

Prefix

First Name

Last Name

Primary Caregiver

Yes No

Relationship to Student

Address

Address Line 2

City

Suburb

Post Code

Work Place (Company Name)

Home Phone

Work Phone

Mobile Phone

Parent/Caregiver Details (2)

Prefix

First Name

Last Name

Primary Caregiver

Yes No

Relationship to Student

Address

Address Line 2

City

Suburb

Post Code

Work Place (Company Name)

Home Phone

Work Phone

Mobile Phone

Emergency Contact - Alternative to Caregiver

Prefix

First Name

Last Name

Relationship to Student

Home Phone

Work Phone

Mobile Phone

Health

Allergies

Medication

Hearing

Vision

Speech

Other Health Issues

Special Learning and Behavioural Needs

Please write medication name(if held at school), Dosage, Frequency

Medical Center Name

Doctor's Name

Phone

The school may administer panadol for pain relief

Yes No

I give permission for school staff to administer general first aid. I agree that the school will take action on my behalf in the event of a sudden medical emergency (illness or injury). Staff are not permitted to give any medication without consent.

Yes No

Custody/Access Arrangements

Court Order Issued

Yes No

Documents

Proof of address

Student's Birth Certificate/Passport

Student's Passport

Parent's Passport

Student's Visa

ICT Agreement form

Additional Fields

Please write siblings (who have attended in the past or will attend in the future) name & date of birth

I give permission for my child’s name, image and school work to be displayed and published where appropriate e.g newsletter, school website, classroom displays, school promotion etc

Yes No

Privacy & Policy

Permissions

I have read and understood the privacy statement as below I give permission for Mt Roskill Intermediate School to share information on my child to their future potential intermediate or secondary school. I give permission for Mt Roskill Intermediate School to approach my child's current school to request information which could include academic, learning support and pastoral support.

Privacy Statement

The information collected on this enrolment application will be used by the school for enrolment purposes and forms an essential part of the information held by the school on your child. All information collected around your child's enrolment may be disclosed to appropriate education, health and welfare authorities and for data-gathering purposes by the New Zealand Ministry of Education, in accordance with the principles of the Privacy Act 2020. It will not be disclosed to any other person or agency unless such disclosure is authorised or required by law. Information collected may include academic, learning support and pastoral support. Privacy Act 2020 rights and obligations can be found at www.legislation.govt.nz

Signature

By signing this below, I confirm that the information given in this form is true, complete and accurate.

Full Name

Date

Term Dates 2023

Term 1
Thu 2 Feb – Thu 6 Apr

Term 2
Mon 24 Apr – Fri 30 Jun

Term 3
Mon 17 Jul – Fri 22 Sep

Term 4
Mon 9 Oct – Thu 14 Dec

Contact

Puketāpapa image supplied by Roskill Development

Announcements :

Online Enrolment

Online Enrolment

Student Details

Ethnicity

Parent/Caregiver Details (1)

Parent/Caregiver Details (2)

Emergency Contact - Alternative to Caregiver

Health

Custody/Access Arrangements

Documents

Additional Fields

Privacy & Policy

Signature

Term Dates 2023

Contact

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